Cerrahi Tedavi Uygulanan Kalça Kırığı olan Geriatrik Hastalardaki Erken Dönem Mortalite Oranları ve Cerrahi Tipleri
Abstract
Amaç: Bu çalışmanın amacı, basit düşme sonrası kalça kırığı gelişen ve cerrahi olarak tedavi edilen 65 yaş üstü hastalarda cerrahi sonrası 30 gün içinde mortalite ile kırık, implant tipi ve cerrahi zamanlaması arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntemler: 01 Ocak 2010 - 31 Temmuz 2020 tarihleri Düzce Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalına başvuran hastalar incelendi. Bu hastalar arasından belirtilen tarihler arasında izole kalça kırığı tanısı ile protez veya proksimal femoral çivi/plak vida ameliyatı yapılan 65 yaş üstü hastalarda cinsiyet, yaş, ameliyat zamanı, ameliyat tipi ve ameliyat sonrası mortalite oranları arasındaki ilişki retrospektif olarak değerlendirildi. Bu çalışmada, belirtilen zaman aralığında tedavi edilen 450 hasta değerlendirildi ve 308 hasta çalışmamızın kriterlerini karşıladı.
Bulgular: Mortalite oranları ile cerrahi (implant) arasında istatistiksel olarak anlamlı bir fark vardı (p<0,05). Ayrıca Anestezi tipi ile mortalite oranları arasında istatistiksel olarak anlamlı bir fark vardı (p<0,001). Hastaneye yatış ile ameliyat arasında geçen süre (gün) ve ameliyat ile taburculuk arasında geçen süre (gün) ile mortalite oranları arasında istatistiksel olarak anlamlı bir fark yoktu (p=0,984). Ameliyat yaşı ile mortalite oranları arasındaki fark istatistiksel olarak anlamlıydı (p<0,001).
Sonuç: Bu çalışmada ameliyat sonrası birinci ayda mortalite oranı %8,1 olarak bulundu ve mortaliteyi etkileyen en önemli faktörlerin ameliyat tipi ve anestezi tipi olduğu saptandı.
References
- Karlsson A, Lindelöf N, Olofsson B, Berggren M, Gustafson Y, Nordström P, et al. Effects of geriatric interdisciplinary home rehabilitation on independence in activities of daily living in older people with hip fracture: a randomized controlled trial. Arch Phys Med Rehabil. 2020; 101(4): 571-8.
- Inoue T, Maeda K, Nagano A, Shimizu A, Ueshima J, Murotani K, et al. Undernutrition, sarcopenia, and frailty in fragility hip fracture: advanced strategies for improving clinical outcomes. Nutrients. 2020; 12(12).
- Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, Osman A, Sarquis-Adamson Y, Close J, et al. Evaluation of clinical practice guidelines on fall prevention and management for older adults: A systematic review. JAMA Netw Open. 2021; 4(12): e2138911.
- Dwyer JG, Reynoso JF, Seevers GA, Schmid KK, Muralidhar P, Konigsberg B, et al. Assessing preoperative frailty utilizing validated geriatric mortality calculators and their association with postoperative hip fracture mortality risk. Geriatr Orthop Surg Rehabil. 2014; 5(3): 109-15.
- Pallardo Rodil B, Gómez Pavon J, Menendez Martínez P. Hip fracture mortality: Predictive models. Med Clin (Barc). 2020; 154(6): 221-31.
- Guzon-Illescas O, Perez Fernandez E, Crespi Villarias N, Quiros Donate FJ, Pena M, Alonso-Blas C, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019; 14(1): 203.
- Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018; 19(1): 369.
- Guerra MT, Viana RD, Feil L, Feron ET, Maboni J, Vargas AS. One-year mortality of elderly patients with hip fracture surgically treated at a hospital in Southern Brazil. Rev Bras Ortop. 2017; 52(1): 17-23.
- Ribeiro TA, Premaor MO, Larangeira JA, Brito LG, Luft M, Guterres LW, et al. Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay. Clinics (Sao Paulo). 2014; 69(4): 253-8.
- Karres J, Zwiers R, Eerenberg JP, Vrouenraets BC, Kerkhoffs G. Mortality prediction in hip fracture patients: physician assessment versus prognostic models. J Orthop Trauma. 2022; 36(11): 585-92.
- Barcelo M, Torres OH, Mascaro J, Casademont J. Hip fracture and mortality: study of specific causes of death and risk factors. Arch Osteoporos. 2021; 16(1): 15.
- LeBlanc KE, Muncie HL, Jr., LeBlanc LL. Hip fracture: diagnosis, treatment, and secondary prevention. Am Fam Physician. 2014; 89(12): 945-51.
- Bhandari M, Swiontkowski M. Management of Acute Hip Fracture. N Engl J Med. 2017; 377(21): 2053-62.
- Chang SM, Hou ZY, Hu SJ, Du SC. Inter trochanteric femur fracture treatment in asia: what we know and what the world can learn. Orthop Clin North Am. 2020; 51(2): 189-205.
- Brüggemann H, Dalen I, Bache-Mathiesen LK, Fenstad AM, Hallan G, Fosse L. Incidence and risk factors of intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: 218,423 cases reported to the Norwegian Arthroplasty Register between 1987 and 2020. Acta Orthop. 2022; 93: 405-12.
- Chen DX, Yang L, Ding L, Li SY, Qi YN, Li Q. Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. Medicine (Baltimore). 2019; 98(49): e18220.
- Saul D, Riekenberg J, Ammon JC, Hoffmann DB, Sehmisch S. Hip fractures: therapy, timing, and complication spectrum. Orthop Surg. 2019; 11(6): 994-1002.
- Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, et al. Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists. Anaesthesia. 2021; 76(2): 225-37.
- McDonough CM, Harris-Hayes M, Kristensen MT, Overgaard JA, Herring TB, Kenny AM, et al. Physical therapy management of older adults with hip fracture. J Orthop Sports Phys Ther. 2021; 51(2): Cpg1-cpg81.
- Li L, Bennett-Brown K, Morgan C, Dattani R. Hip fractures. Br J Hosp Med (Lond). 2020; 81(8): 1-10.
- Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018; 49(8): 1458-60.
- Okkaoglu MC, Özdemir M, Şeşen H, Taşkesen A, Demirkale İ, Altay M. Yaşlılarda Kalça kırıklarının epidemiyolojik özelliklerinin retrospektif analizi. Akademik Araştırma Tıp Dergisi. 2016; 1(1): 17-23.
- Nasiri Sarvi M, Luo Y. Sideways fall-induced impact force and its effect on hip fracture risk: a review. Osteoporos Int. 2017; 28(10): 2759-80.
- Lim SK, Beom J, Lee SY, Kim BR, Chun SW, Lim JY, et al. Association between sarcopenia and fall characteristics in older adults with fragility hip fracture. Injury. 2020; 51(11): 2640-7.
- Kuiper BW, Graybill S, Tate JM, Kaufman N, Bersabe D. After the fall: improving osteoporosis treatment following hip fracture. Osteoporos Int. 2018; 29(6): 1295-301.
- Cheung WH, Miclau T, Chow SK, Yang FF, Alt V. Fracture healing in osteoporotic bone. Injury. 2016; 47 Suppl 2: S21-6.
- Seong YJ, Shin WC, Moon NH, Suh KT. Timing of hip-fracture surgery in elderly patients: literature review and recommendations. Hip Pelvis. 2020; 32(1): 11-6.
- Nguyen ET, Posas-Mendoza T, Siu AM, Ahn HJ, Choi SY, Lim SY. Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii. Osteoporos Int. 2018; 29(8): 1827-32.
- Leibold C, Falbo R, Gupta A, Miller R, Pederson JM, Malpe M. A systematic review and meta-analysis of anesthesia type on hip fracture post-surgery outcomes. OTA Int. 2022; 5(3): e204.
- Al-Husinat L, Al Sharie S, Araydah M, Al Modanat Z, Ismail MIA, Heilat HB, et al. Clinical characteristics of spinal versus general anaesthesia in older patients undergoing hip fracture repair surgery in jordan: a multicentre study. J Pers Med. 2023; 13(11): 1611.
Early Mortality Rates and Types of Surgery in Geriatric Patients with Hip Fractures Undergoing Surgical Treatment
Abstract
Aim: The aim of this study was to investigate the relationships between mortality within 30 days after surgery and fracture incidence, implant type and surgical timing in patients older than 65 years who developed hip fractures after a simple fall and were treated surgically.
Material and Methods: Patients admitted to the emergency department of the xxx Department of Orthopedics and Traumatology between 01 January 2010 and 31 July 2020 were included. Among these patients, the relationships between sex, age, duration of surgery, type of surgery and postoperative mortality rate were retrospectively evaluated in patients older than 65 years who were diagnosed with isolated hip fracture and who underwent prosthesis or proximal femoral nail/plate screw surgery between the specified dates. In this study, 450 patients treated within the specified time intervals were evaluated, and 308 patients fulfilled the criteria of our study.
Results: There was a statistically significant difference between the mortality rate and surgery (implant) (p<0.05). Additionally, there was a statistically significant difference between the mortality rate and the type of anesthesia (p<0.001). There was no statistically significant difference between the time between hospitalization and surgery (days) or between surgery and discharge (days) or between hospitalization and mortality (p=0.984). The difference between age at operation and mortality rate was statistically significant (p<0.001).
Conclusion: In this study, the mortality rate in the first month after surgery was 8.1%, and the most important factors affecting mortality were the type of surgery and type of anesthesia.
Keywords
References
- Karlsson A, Lindelöf N, Olofsson B, Berggren M, Gustafson Y, Nordström P, et al. Effects of geriatric interdisciplinary home rehabilitation on independence in activities of daily living in older people with hip fracture: a randomized controlled trial. Arch Phys Med Rehabil. 2020; 101(4): 571-8.
- Inoue T, Maeda K, Nagano A, Shimizu A, Ueshima J, Murotani K, et al. Undernutrition, sarcopenia, and frailty in fragility hip fracture: advanced strategies for improving clinical outcomes. Nutrients. 2020; 12(12).
- Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, Osman A, Sarquis-Adamson Y, Close J, et al. Evaluation of clinical practice guidelines on fall prevention and management for older adults: A systematic review. JAMA Netw Open. 2021; 4(12): e2138911.
- Dwyer JG, Reynoso JF, Seevers GA, Schmid KK, Muralidhar P, Konigsberg B, et al. Assessing preoperative frailty utilizing validated geriatric mortality calculators and their association with postoperative hip fracture mortality risk. Geriatr Orthop Surg Rehabil. 2014; 5(3): 109-15.
- Pallardo Rodil B, Gómez Pavon J, Menendez Martínez P. Hip fracture mortality: Predictive models. Med Clin (Barc). 2020; 154(6): 221-31.
- Guzon-Illescas O, Perez Fernandez E, Crespi Villarias N, Quiros Donate FJ, Pena M, Alonso-Blas C, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019; 14(1): 203.
- Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018; 19(1): 369.
- Guerra MT, Viana RD, Feil L, Feron ET, Maboni J, Vargas AS. One-year mortality of elderly patients with hip fracture surgically treated at a hospital in Southern Brazil. Rev Bras Ortop. 2017; 52(1): 17-23.
- Ribeiro TA, Premaor MO, Larangeira JA, Brito LG, Luft M, Guterres LW, et al. Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay. Clinics (Sao Paulo). 2014; 69(4): 253-8.
- Karres J, Zwiers R, Eerenberg JP, Vrouenraets BC, Kerkhoffs G. Mortality prediction in hip fracture patients: physician assessment versus prognostic models. J Orthop Trauma. 2022; 36(11): 585-92.
- Barcelo M, Torres OH, Mascaro J, Casademont J. Hip fracture and mortality: study of specific causes of death and risk factors. Arch Osteoporos. 2021; 16(1): 15.
- LeBlanc KE, Muncie HL, Jr., LeBlanc LL. Hip fracture: diagnosis, treatment, and secondary prevention. Am Fam Physician. 2014; 89(12): 945-51.
- Bhandari M, Swiontkowski M. Management of Acute Hip Fracture. N Engl J Med. 2017; 377(21): 2053-62.
- Chang SM, Hou ZY, Hu SJ, Du SC. Inter trochanteric femur fracture treatment in asia: what we know and what the world can learn. Orthop Clin North Am. 2020; 51(2): 189-205.
- Brüggemann H, Dalen I, Bache-Mathiesen LK, Fenstad AM, Hallan G, Fosse L. Incidence and risk factors of intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: 218,423 cases reported to the Norwegian Arthroplasty Register between 1987 and 2020. Acta Orthop. 2022; 93: 405-12.
- Chen DX, Yang L, Ding L, Li SY, Qi YN, Li Q. Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. Medicine (Baltimore). 2019; 98(49): e18220.
- Saul D, Riekenberg J, Ammon JC, Hoffmann DB, Sehmisch S. Hip fractures: therapy, timing, and complication spectrum. Orthop Surg. 2019; 11(6): 994-1002.
- Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, et al. Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists. Anaesthesia. 2021; 76(2): 225-37.
- McDonough CM, Harris-Hayes M, Kristensen MT, Overgaard JA, Herring TB, Kenny AM, et al. Physical therapy management of older adults with hip fracture. J Orthop Sports Phys Ther. 2021; 51(2): Cpg1-cpg81.
- Li L, Bennett-Brown K, Morgan C, Dattani R. Hip fractures. Br J Hosp Med (Lond). 2020; 81(8): 1-10.
- Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018; 49(8): 1458-60.
- Okkaoglu MC, Özdemir M, Şeşen H, Taşkesen A, Demirkale İ, Altay M. Yaşlılarda Kalça kırıklarının epidemiyolojik özelliklerinin retrospektif analizi. Akademik Araştırma Tıp Dergisi. 2016; 1(1): 17-23.
- Nasiri Sarvi M, Luo Y. Sideways fall-induced impact force and its effect on hip fracture risk: a review. Osteoporos Int. 2017; 28(10): 2759-80.
- Lim SK, Beom J, Lee SY, Kim BR, Chun SW, Lim JY, et al. Association between sarcopenia and fall characteristics in older adults with fragility hip fracture. Injury. 2020; 51(11): 2640-7.
- Kuiper BW, Graybill S, Tate JM, Kaufman N, Bersabe D. After the fall: improving osteoporosis treatment following hip fracture. Osteoporos Int. 2018; 29(6): 1295-301.
- Cheung WH, Miclau T, Chow SK, Yang FF, Alt V. Fracture healing in osteoporotic bone. Injury. 2016; 47 Suppl 2: S21-6.
- Seong YJ, Shin WC, Moon NH, Suh KT. Timing of hip-fracture surgery in elderly patients: literature review and recommendations. Hip Pelvis. 2020; 32(1): 11-6.
- Nguyen ET, Posas-Mendoza T, Siu AM, Ahn HJ, Choi SY, Lim SY. Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii. Osteoporos Int. 2018; 29(8): 1827-32.
- Leibold C, Falbo R, Gupta A, Miller R, Pederson JM, Malpe M. A systematic review and meta-analysis of anesthesia type on hip fracture post-surgery outcomes. OTA Int. 2022; 5(3): e204.
- Al-Husinat L, Al Sharie S, Araydah M, Al Modanat Z, Ismail MIA, Heilat HB, et al. Clinical characteristics of spinal versus general anaesthesia in older patients undergoing hip fracture repair surgery in jordan: a multicentre study. J Pers Med. 2023; 13(11): 1611.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | January 16, 2024 |
| Submission Date | September 5, 2023 |
| Published in Issue | Year 2024 Volume: 14 Issue: 1 |
